Administrator

ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary

This position is responsible for the development, testing and maintenance of benefit plans including authorization and timely filing requirements for Independent Living Systems/Royal Health Care clients. Functions include, but are not limited to, supporting the Claims, Provider Services and Provider Data Management departments, as well as, educating staff and clients as necessary.

Analyzes changes of product design to determine the effect on the end product design and function and determines and prepares documentation necessary for change. Coordinates with customers and manufacturers to determine a process for change reporting. Reviews released engineering change data and changes documenting activities to ensure adherence to configuration management procedures and policies.

Essential Functions

1. Develop, code and test benefit plans programmed in the eClaims claim processing system
2. Assure compliance with regulatory requirements
3. Defining and delivery of reports  
4. Maintain written documentation supporting the benefit development and testing process, in addition to, assisting co-workers in the development of departmental policies and procedures
5. Perform various tasks associated with new client implementation and system migration from other processing systems into eClaims including, but not limited to, benefit building 
6. Analyze claim suspensions to identify and program modifications essential to optimizing claim auto-adjudication.
7. Test, document and educate staff about system enhancements.
8. Support staff in answering questions pertaining to claim adjudication including EDI and OCR functionality.
9. Troubleshoot EDI issues and implement corrective action as appropriate. 
10. Effectively communicate up-to-date information to all staff including management
11. Participate in corporate projects as required.
12. Assist with high volume workloads as necessary.
13. Flexible day/evening hours
14. Direct contact with current and potential clients as necessary
15. Occasional travel required.

Education and Experience

Bachelor's degree or 0-3 years of experience in the field 

• Experience including Medical Claim Examiner/Coder, Business Analyst or Trainer
• Knowledge of UB04 / CMS1500 claims, ICD-9, ICD-10/ Revenue / CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission, Medicare and Medicaid reimbursement methodologies including APR   DRG / Exempt Units / APG / RBRVS / APC.
• Knowledge of eClaims and Boolean logic preferred
• Proven ability to effectively and efficiently analyze data and summarize in an organized and professional manner
• Ability to read and interpret contracts and other related documents required
• Function in a fast-paced environment that requires prioritizing workloads and multi-tasking to complete projects on time.
• Team player that can work well independently and make decisions without excessive supervisory oversight.
• Excellent verbal, written and presentation skills required.
• Proficient in Microsoft Office (Word, Excel, PowerPoint, and Access) require  
• Ethical Conduct. 
• Strategic-Critical Thinking. 
• Leadership.
• Decision Making. 
• Financial Management. 
• Communications Proficiency. 
• Presentation Skills.        

EEO STATEMENT 

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.